Effects of Traditional Chinese Decoctions on Glycemic and Renal Outcomes in Diabetic Kidney Disease: A Systematic Review and Network Meta-analysis.

This network meta-analysis evaluated traditional Chinese medicine (TCM) decoctions as adjuncts to conventional treatment for diabetic kidney disease (DKD). The outcomes included glycated hemoglobin A1c (HbA1c), 24-hour urinary protein excretion (24 hUP), serum creatinine (Cr), and blood urea nitrogen (BUN). PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to January 20, 2026, for randomized controlled trials of traditional Chinese herbal decoctions for DKD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. Bayesian network meta-analysis was conducted using R 4.4.1 and Stata 15, with mean differences and 95% credible intervals calculated for continuous outcomes and SUCRA values used to rank interventions. Ninety-seven trials involving 8,956 participants were included. YQYYHXT, FFHQT, and YSTLT were associated with greater reductions in HbA1c than control treatment, with YQYYHXT ranking highest. JWTHCQT ranked highest for reducing 24-hour urinary protein, YSTLT ranked highest for lowering serum creatinine, and ZWT ranked highest for reducing blood urea nitrogen. Several decoctions may improve glycemic and renal outcomes; however, methodological limitations, heterogeneity, and reliance on ranking probabilities warrant cautious interpretation. Further high-quality randomized trials are needed.